TY - JOUR
T1 - Subjective global assessment of nutritional status is strongly associated with mortality in chronic dialysis patients
AU - de Mutsert, Renée
AU - Grootendorst, Diana C.
AU - Boeschoten, Elisabeth W.
AU - Brandts, Hans
AU - van Manen, Jeannette G.
AU - Krediet, Raymond T.
AU - Dekker, Friedo W.
AU - AUTHOR GROUP
AU - Apperloo, A. J.
AU - Bijlsma, J. A.
AU - Boekhout, M.
AU - Boer, W. H.
AU - van der Boog, P. J. M.
AU - Büller, H. R.
AU - van Buren, M.
AU - de Charro, F. Th
AU - Doorenbos, C. J.
AU - van den Dorpel, M. A.
AU - van Es, A.
AU - Fagel, W. J.
AU - Feith, G. W.
AU - de Fijter, C. W. H.
AU - Frenken, L. A. M.
AU - van Geelen, J. A. C. A.
AU - Gerlag, P. G. G.
AU - Gorgels, J. P. M. C.
AU - Grave, W.
AU - Huisman, R. M.
AU - Jager, K. J.
AU - Jie, K.
AU - Koning-Mulder, W. A. H.
AU - Koolen, M. I.
AU - Kremer Hovinga, T. K.
AU - Lavrijssen, A. T. J.
AU - Luik, A. J.
AU - van der Meulen, J.
AU - Parlevliet, K. J.
AU - Raasveld, M. H. M.
AU - van der Sande, F. M.
AU - Schonck, M. J. M.
AU - Schuurmans, M. M. J.
AU - Siegert, C. E. H.
AU - Stegeman, C. A.
AU - Stevens, P.
AU - Thijssen, J. G. P.
AU - Valentijn, R. M.
AU - Vastenburg, G. H.
AU - Verburgh, C. A.
AU - Vincent, H. H.
AU - Vos, P. F.
PY - 2009
Y1 - 2009
N2 - BACKGROUND: The subjective global assessment of nutritional status (SGA) is used to assess the nutritional status of chronic dialysis patients, but longitudinal data in relation to mortality risk are lacking. OBJECTIVE: Our objective was to study the long-term and time-dependent associations of the SGA with mortality risk in chronic dialysis patients. DESIGN: In a prospective, longitudinal, observational, multicenter study of incident dialysis patients, the 7-point SGA [7 = normal nutritional status; 1 = severe protein-energy wasting (PEW)] was assessed 3 and 6 mo after the start of dialysis and subsequently every 6 mo during 7 y of follow-up. With Cox regression analysis, we calculated hazard ratios (HRs) of the baseline and time-dependent SGA measurements, adjusted for age, sex, treatment modality, primary kidney diseases, and comorbidity. RESULTS: In total, 1601 patients were included [mean (+/-SD) age: 59 +/- 15 y; 61% men; 23% with moderate PEW (SGA(4-5)), and 5% with severe PEW (SGA(1-3))]. There was a dose-dependent trend of the 7-point SGA with mortality. Compared with a normal nutritional status at baseline, SGA(4-5) (HR: 1.6; 95% CI: 1.3, 1.9) and SGA(1-3) (HR: 2.1; 95% CI: 1.5, 2.8) were associated with an increase in 7-y mortality. Time-dependently, these associations were stronger: SGA(4-5) (HR: 2.1; 95% CI: 1.7, 2.5) and SGA(1-3) (HR: 5.0; 95% CI: 3.8, 6.5). CONCLUSIONS: In dialysis patients, PEW at baseline assessed with SGA was associated with a 2-fold increased mortality risk in 7 y of follow-up. Time-dependently, this association was even stronger, which indicated that PEW was associated with a remarkably high risk of short-term mortality. These data imply that the 7-point SGA may validly distinguish different degrees of PEW associated with increasing risks of mortality
AB - BACKGROUND: The subjective global assessment of nutritional status (SGA) is used to assess the nutritional status of chronic dialysis patients, but longitudinal data in relation to mortality risk are lacking. OBJECTIVE: Our objective was to study the long-term and time-dependent associations of the SGA with mortality risk in chronic dialysis patients. DESIGN: In a prospective, longitudinal, observational, multicenter study of incident dialysis patients, the 7-point SGA [7 = normal nutritional status; 1 = severe protein-energy wasting (PEW)] was assessed 3 and 6 mo after the start of dialysis and subsequently every 6 mo during 7 y of follow-up. With Cox regression analysis, we calculated hazard ratios (HRs) of the baseline and time-dependent SGA measurements, adjusted for age, sex, treatment modality, primary kidney diseases, and comorbidity. RESULTS: In total, 1601 patients were included [mean (+/-SD) age: 59 +/- 15 y; 61% men; 23% with moderate PEW (SGA(4-5)), and 5% with severe PEW (SGA(1-3))]. There was a dose-dependent trend of the 7-point SGA with mortality. Compared with a normal nutritional status at baseline, SGA(4-5) (HR: 1.6; 95% CI: 1.3, 1.9) and SGA(1-3) (HR: 2.1; 95% CI: 1.5, 2.8) were associated with an increase in 7-y mortality. Time-dependently, these associations were stronger: SGA(4-5) (HR: 2.1; 95% CI: 1.7, 2.5) and SGA(1-3) (HR: 5.0; 95% CI: 3.8, 6.5). CONCLUSIONS: In dialysis patients, PEW at baseline assessed with SGA was associated with a 2-fold increased mortality risk in 7 y of follow-up. Time-dependently, this association was even stronger, which indicated that PEW was associated with a remarkably high risk of short-term mortality. These data imply that the 7-point SGA may validly distinguish different degrees of PEW associated with increasing risks of mortality
U2 - 10.3945/ajcn.2008.26970
DO - 10.3945/ajcn.2008.26970
M3 - Article
C2 - 19144733
SN - 0002-9165
VL - 89
SP - 787
EP - 793
JO - American journal of clinical nutrition
JF - American journal of clinical nutrition
IS - 3
ER -
SDG 3 Good Health and Well-being